Stacie B. Dusetzina (
Juliette Cubanski is deputy director of the Program on Medicare Policy, Henry J. Kaiser Family Foundation, in San Francisco, California.
Health Aff (Millwood). 2020 Aug;39(8):1326-1333. doi: 10.1377/hlthaff.2019.01694.
Recent press reports and other evidence suggest that Medicare Part D plans may be encouraging the use of brand-name drugs instead of generics. However, the scope of such practices is unclear. We examined Medicare Part D formulary coverage and tier placement of matched pairs of brand-name drugs and generics to quantify how often preferred formulary placement of brand-name drugs is occurring within and across Part D plans and to assess the cost implications for Medicare and its beneficiaries. We found that in 2019, 84 percent of 4,176,772 Part D plan-product combinations had generic-only coverage (that is, the brand-name counterparts were not covered). Another 15 percent covered both the brand-name and generic versions of a product. For the small number of products whose brand-name versions were covered preferentially to their generic equivalents, beneficiary and Medicare prices were generally low for both products. Overall, we found that most Part D plan formularies are designed to encourage the use of generics rather than their brand-name counterparts. Policy makers should continue to monitor Part D formulary coverage patterns to ensure consistent and generous coverage for generic drugs, given their important role in reducing prescription drug spending.
最近的新闻报道和其他证据表明，医疗保险处方药部分计划可能鼓励使用品牌药物而不是仿制药。然而，此类做法的范围尚不清楚。我们检查了医疗保险处方药处方集覆盖范围和匹配的品牌药物和仿制药的定价位置，以量化品牌药物首选处方集位置在处方药计划内部和跨计划发生的频率，并评估其对医疗保险及其受益人的成本影响。我们发现，在 2019 年，4176772 个医疗保险处方药计划-产品组合中有 84%仅涵盖仿制药（即不涵盖品牌药物的对应物）。另外 15%涵盖了产品的品牌名称和通用版本。对于品牌名称版本优先于其通用等效物覆盖的少数产品，受益人和医疗保险的价格对两种产品通常都很低。总体而言，我们发现大多数医疗保险处方药计划的处方集旨在鼓励使用仿制药而不是其品牌药物。鉴于它们在降低处方药支出方面的重要作用，政策制定者应继续监测医疗保险处方集覆盖模式，以确保对仿制药的一致和慷慨覆盖。
